7 Treatments for Basal Cell Carcinoma

A diagnosis of basal cell carcinoma (BCC) can be scary, but with early medical care, this common type of skin cancer can usually be cured. Several surgical and nonsurgical treatment options are available for BCC, and many have high cure rates.

Most cases of BCC can be treated with outpatient procedures. These treatments usually don’t cause much pain, and the wounds often heal with minimal scarring.

Your doctor or dermatologist will explain which treatment is best for you based on factors such as:

• The location of the skin cancer
• The tumor’s size and depth
• Your medical history and general health
• Any treatment you’ve already received for the tumor

If you have questions about BCC treatment, talk with your doctor about your condition and individual risk factors. Early treatment can help you avoid bigger procedures.

Some BCC treatments can leave scars, especially if the tumor is large, deep, or in a visible area such as the face. Treating BCC early may help you avoid a larger procedure later. Before trying a new treatment, talk with your healthcare team about possible side effects.

Here’s more information about treatment options for BCC and how doctors decide which treatment may be best.

1. Surgery

Several types of surgery are used to treat BCC, depending on how deeply the tumor has grown into the layers of the skin.

Mohs Surgery

In Mohs surgery, also called Mohs micrographic surgery, a tumor is removed one very thin layer of skin at a time. Each layer is quickly frozen and examined under a microscope to check for cancer cells at the margins. If cancer remains, another layer of skin is removed, and the process is repeated until no cancer cells are found.

This type of surgery takes time and is designed to preserve as much healthy skin as possible. Mohs surgery may be used if standard excision hasn’t worked or if the BCC is near the eyes, center of the face, ears, or fingers. This procedure may be recommended for larger or deeper tumors or when there’s a high risk that the BCC could return after treatment.

Curettage and Electrodesiccation

In curettage and electrodesiccation, the lesion is scraped with a sharp, looped instrument called a curette. An electrode is then used on the area to destroy any remaining cancer cells, and the process may be repeated if needed. This treatment will leave a scar.

Shave excision is a similar treatment in which the tumor is shaved off with a blade. Both shave excision and curettage and electrodesiccation are performed under local anesthesia and do not require stitches. These procedures are used for superficial BCC tumors in the epidermis (top layer of skin) and are usually performed on lesions on the torso, arms, and legs.

2. Ablative Therapy

Ablative treatments use extreme heat or cold to destroy diseased tissue. Ablative therapy is less invasive than some types of surgery. Two types of ablative therapy may be used to treat BCC.

Cryotherapy

Cryotherapy, also called cryosurgery, is a procedure in which a doctor applies liquid nitrogen to freeze a lesion. The lesion eventually crusts over and falls off, leaving healthy skin behind.

Cryotherapy is mainly used for superficial or small BCC tumors. It may also be used for people with bleeding disorders or people who can’t safely have anesthesia.

Laser Surgery

Laser surgery isn’t approved by the U.S. Food and Drug Administration (FDA) for the treatment of BCC, but doctors sometimes use it off-label (outside its approved use). This option may be recommended for superficial BCC when other treatments haven’t worked. Lasers use a concentrated beam of light to heat and destroy the tumor.

3. Photodynamic Therapy

In photodynamic therapy, doctors apply a substance to make a BCC tumor sensitive to light. The tumor is then treated with a special type of light or, in some cases, controlled exposure to sunlight. This triggers a reaction that destroys cancer cells.

After photodynamic therapy, it’s important to avoid exposure to sunlight and ultraviolet light from tanning beds for at least 48 hours. This helps prevent the treatment from being activated and damaging healthy skin. This treatment is sometimes recommended for superficial BCC lesions.

4. Radiation Therapy

Radiation therapy may be recommended for BCC if surgery is difficult or when someone has a high risk of surgical complications. Radiation therapy uses X-rays or high-energy particle beams to destroy cancer cells. It may be used alone or after surgery to kill any remaining cancer cells.

5. Topical Medicine

Topical medications are applied directly to the skin as creams or ointments. Two types of topical medicines are used to treat BCC.

6. Targeted Medications

In rare cases of advanced BCC that has grown beyond the deeper layers of the skin, targeted medications may be recommended. These medications may also be used when BCC has spread to other areas of the body or hasn’t responded to other forms of treatment.

The FDA has approved two targeted medications, vismodegib (Erivedge) and sonidegib (Odomzo), to treat BCC. These drugs are taken by mouth and block the Hedgehog signaling pathway. This pathway helps control cell growth and is linked to cancer development.

7. Immunotherapy

Immunotherapy for BCC works by blocking immune system molecules called checkpoints. Cancer cells can use these checkpoints to avoid being attacked by the immune system. Immunotherapy drugs called checkpoint inhibitors help the immune system recognize and attack cancer cells.

The FDA has approved one immunotherapy drug, cemiplimab-rwlc (Libtayo), to treat some forms of advanced BCC. Cemiplimab-rwlc is given intravenously.

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